ITW Oberflächentechnik GmbH & Co. KG
Justus-von-Liebig-Straße 31
D-63128 Dietzenbach
Telefon +49 (0) 6074 / 403-1
Telefax +49 (0) 6074 / 403-281
Date: ..................................
Examiner: ...................................
DEALER STAMP:
ADDRESS OF OPERATOR:
Name: ......................................................
Street: ......................…….........................
Postcode/Town: .......................................
Contact:........................................Phone: ...........……..........
Tested unit:
Manufacturer: ..................................................
Type: .........................................................
Eqpt.-No.: ..................................................
Year of manufacture: .................................
System components used:
O Airless pump
O Airless gun
O Spray material line
O Pump head Cart O
Triprod O
Wall bracket O
Tested components complies not tested does not
comply
retrofit recom-
mended
General condition of system
Jet stream unit
Equipment name plate
Safety valve
Pressure gauge fitting
Pressure relief valve
Jet stream unit with heater
Temperature limitation / control
Temperature display
Spraying device
Max. pressure identification
Equipment number identification
Efficiency
Safety equipment
Hoses and fittings
Hose identification
Fitting identification
Grounding
Between components
Overall system
Measuring of resistance (1 MO)
Operating instructions
Function of the overall system
User instructions
Technical condition
Safe condition
Health and safety at work regulations
Overall assessment of the examination
Comments:
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